Methyl alchohol poisoning

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Methyl alchohol poisoning

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<ul><li> 1. MECHANISM OF ACTION METHANOL FORMALDEHYDE FORMIC ACID ALDEHYDE DEHYDROGENASEALCOHOL DEHYDROGENASE METHANOL ITSELF NOT TOXIC. FORMALDEHYDE VERY TOXIC, BUT VERY RAPIDLY METABOLISED TO FORMIC ACID. FORMIC ACID RESPONSIBLE FOR THE TOXICITY RELATED TO METHANOL INGESTIONS </li></ul> <p> 2. MECHANISM OF ACTION METHANOL FORMALDEHYDE FORMIC ACID ACIDOSIS Early stage of poisoning ACIDOSIS TISSUE HYPOXIA LACTIC ACID PRODUCTION CIRCULATORY FAILURE GENERAL TOXICITY INCREASED FORMIC ACID TOXICITY OCULAR TOXICITY INHIBITION OF MITOCHONDRIAL RESPIRATION CIRCULUS HYPOXICUS 3. SIGNS AND SYMPTOMS In small doses Dizziness (vertigo) Headache Nausea &amp; Vomitting Abdominal pain In Moderate doses Tachy cardia Drowsiness Mydriasis (dilation of the pupil) In High doses Metabolic Acidosis Convulsions Retinal Oedema COMA Respiratory failure and death 4. SIGNS AND SYMPTOMS CNS CONVULSIONS, PROGRESSING TO COMA RETINAL - BLURRED VISION, PHOTOPHOBIA, VISUAL ACUITY LOSS, DILATED NON-REACTIVE PUPILS, OPTIC NERVE BECOMES OEDEMATOUS GIT - NAUSEA, VOMITING CARDIAC - TACHYCARDIA, HYPERTENSION PROGRESSING TO HYPOTENSION AND CARDIOGENIC SHOCK RESPIRATORY - TACHYPNOEA 5. INVESTIGATION BLOOD METHANOL LEVEL (by titration method) ABG Fundoscopy ( to examine retinal 6. Image reference http://www.meajo.org/article.asp?issn=0974- 9233;year=2013;volume=20;issue=1;spage=92;epage=94;aulast=Iscan 7. TREATMENT (i) ABC (ii) CORRECTION OF METABOLIC ACIDOSIS BICARBONATE (AGGRESSIVE TREATMENT) (iii) Ethanol ( competitive binding to ADH) (iv) Haemodialysis (v) Folinic acid (elemination of formic acid) (vi) Fomepizole 8. CASE STUDY 9. Name : Mr. X Age :58 Sex : Male DOA : 27/7/13 CHIEF COMPLAINTS : C/O Right Shoulder pain in the morning following which he faints and then goes into unconscious state convulsions (before going unconscious) (tongue bite mark seen) HISTORY OF PRESENT ILLNESS : N/K/C/O BA / HTN / Epilepsy Consumption of high levels of alcohol (12 hrs ago) PAST MEDICAL HISTORY : Known Diabetic, wound present over the right foot for over 7 months PERSONAL HISTORY/ SOCIAL HABITS K/C/O Alcoholism 25 yrs Smoking 14 yrs 10. PHYSICAL EXAMINATION : Pt was Unconscious/ disoriented ON EXAMINATION : Temp : 103 F BP : 110 / 70 Pulse : 88 RR 16 SYSTEMIC EXAMINATION : CVS: S1 S2 +ve CNS : pupils not responding (dilated) Initially responded to painful stimuli followed by no response RS : NVBS P/A : Soft 11. Metabolic acidosis Pt. Name is hidden 12. OTHER TESTS : CT - subcortical white matter and basal ganglia hyperintensity and low-signal- intensity ECG Bradycardia DIAGNOSIS Alcohol Poisoning ( Methyl Alcohol) 13. TREATMENT Initially - Stomach wash given, Commercially available Ethanol 10 % soln (30 ml) DRUGS DOSE R.O.A FREQ No of Days Inj Fosolin (Fos Phenytoin) (anti convulsant) 150 mg IV stat 1 Inj Ceftum (cefuroxime) 250 mg IV OD 1 Inj Pantocid (pantoprazole) 40 mg IV BD 1 Inj Strocit ( citicoline) (a Neurotonics/Neurotrophics) 250 mg IV BD 1 Inj Lasix 20 mg IV Stat 1 Inj Sodium Bicarb 500 mL IV Stat 1 14. PROGNOSIS OF CASE The Subject goes into irreversible COMA Respiratory Depression occours ( put on mechanical ventilation) Sudden Cardiac Failure Death </p>